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Susan Blumenthal, M.D. Headshot

Health in All Policies

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Co-authored by Denis Cortese, M.D.

At the heart of current health care reform discussions -- which focus on expanding access to care and establishing mechanisms to finance broader coverage as well as reduce rapidly escalating costs -- must be the promotion of good health and the prevention of disease.

Good health is essential to the economic prosperity and wellbeing of the American people. Individually, we are less productive when we become ill; collectively, our nation is less secure when burdened with the high cost of disease. Today, with 45 percent of Americans suffering from a chronic condition and a national fiscal crisis, both our nation's health and economic security are in peril.

Deteriorating health is a major driver of this crisis. One in five Americans smoke and 66 percent of adults are obese or overweight, fueling a chronic disease epidemic and skyrocketing health care costs. As childhood obesity rates dramatically rise, American children may, for the first time ever, live shorter lives and be less healthy than their parents.

Just as Americans are ailing, so too is our health care system. The U.S. health care system suffers from considerable fragmentation, inefficiencies and inequities. The United States spends nearly twice as much on health care, per person, as any other nation, and the health sector constitutes one sixth of our economy. Yet this significant investment delivers shockingly poor results. America ranks 49th on life expectancy worldwide, 37th on overall health status and performs the worst among industrialized countries at avoiding premature deaths through timely and effective medical care.

Our nation's poor rankings are due to several deficiencies in the U.S. health system: many Americans lack quality, affordable coverage, significant health disparities are not being addressed and disease prevention and health promotion are not priorities. Without meaningful health insurance reform, the number of uninsured Americans could swell from over 47 million today to over 65 million by 2019. And while preventable conditions account for 70 percent of our nation's health care costs, only 2-3 percent of the health care budget is spent on prevention. The bottom line: we spend far too much on health care to receive so little health in return.

The state of our nation's health is further jeopardized by the economic downturn. During previous recessions, Americans' health has often been among the first casualties. But while there are no bailouts for poor health, there is reason to think that fixing our health care system could help the economy rebound. Many American businesses report struggling because they pay more for their employees' health care than for the products they manufacture or sell, while nearly two-thirds of personal bankruptcies in 2007 were due in part to medical debt.

Our country urgently needs -- and Americans categorically deserve -- a better health system. As we consider how best to achieve this goal, it's important to recognize that America's health crisis has neither a single cause nor a silver bullet solution. Patchwork reform would yield only marginal success.

In the past, many policymakers and stakeholders have focused too narrowly on the financing and distribution of medical services. Today's leaders must not repeat this mistake. Instead, a comprehensive, integrated strategy is needed that fosters health in all policies.

For medical care alone does not determine our health status. Decades of scientific research shows that our health habits -- the choices we make regarding tobacco, alcohol, food and exercise -- and the communities we call home -- with their transportation systems, workplaces, schools and environments -- all impact our health. That's why health promotion and disease prevention must be cornerstones of health reform. A broad range of policy changes, such as regulating tobacco products, implementing healthier school lunch programs, encouraging fruit and vegetable consumption, labeling food content in supermarkets and restaurants, funding bicycle paths and pedestrian-friendly sidewalks, expanding parkland development and improving air and water quality -- when taken together -- can dramatically improve the health of Americans.

"Health in all Policies" should be the clarion call for a health system re-engineered for the 21st century. Such an approach requires the mobilization and coordination of over 40 federal agencies whose policies influence health, including the U.S. Departments of Health and Human Services, Agriculture, Housing and Urban Development, Homeland Security, Transportation, Education, Interior and State, as well as the Environmental Protection Agency. Because coordinating this effort requires leadership from the very top, a Presidential Call to Action for a Healthier U.S. is needed to set a bold framework for improving health in the United States.

To facilitate this nationwide effort, government initiatives are needed that foster collaboration and innovation. Establishing a Federal Interagency Council charged with developing and implementing a national strategy to advance health would help synergize the work of federal agencies. In parallel, a new Office of Health Innovation could serve as an incubator for ideas, designing novel, cross-cutting programs. Creating a Healthy U.S. Clearinghouse online could provide one-stop shopping for health resources and best practices, bridging today's 15-year science-to-service gap by making lifesaving information available to the public and health care providers instantaneously. Additionally, supporting community-based prevention programs through a Prevention and Wellness Trust could speed the transformation to a healthier America.

The federal government should also lead by incorporating health promotion and disease prevention into federal health insurance plans, which cover nearly one third of Americans. Medicare, Medicaid, the Military and Veterans health systems and the Federal Employees Health Benefits Program should incorporate quality-enhancing and cost-saving reforms that provide strong incentives for health care providers to implement clinical and community-based preventive services, chronic disease management programs and cutting-edge information technology. Serving as laboratories of innovation, federal health programs should support the evaluation of new ideas and implement best practices to help transform the U.S. health system.

But federal government improvements alone are not sufficient. The key to progress is a partnership between government and the American people. Any national strategy to transform the health system must include strong public-private partnerships that unite families, businesses, health care providers and a broad spectrum of organizations across our country.

As Robert F. Kennedy once said, "Few will have the greatness to bend history itself; but each of us can work to change a small portion of events." Together, perhaps, we will find a way to bend history toward a healthier future for us all.

Rear Admiral Susan Blumenthal, MD (ret.), former U.S. Assistant Surgeon General, is Director of the Health and Medicine Program at the Center for the Study of the Presidency and Congress (CSPC). Denis Cortese, MD, is President and CEO of Mayo Clinic. The authors are Co-Chairs of the Commission on U.S. Federal Leadership in Health and Medicine: Charting Future Directions, a CSPC initiative.